Underactive bladder is a condition in which you aren't able to empty your bladder completely – or at all. You may hesitate before urine flows, or you may have to push urine out. Your urine may only come out in dribbles. Treatment options for underactive bladder symptoms are listed below.
Some of these therapies are the same as for overactive bladder, and again, are often the first therapies used to treat neurogenic bladder. They consist of changes in the way you live day-to-day to help control symptoms.
Scheduled voiding: With this method, you follow a daily schedule of going to the bathroom. Instead of going when you feel the urge, you go to the bathroom at set times during the day. Depending on how often you go to the bathroom now, your health care provider may ask you to urinate every 2 to 4 hours, whether you feel you have to go or not.
Double voiding: After urinating, wait a few minutes and then try again to empty your bladder.
Bladder diary: Writing down when you make trips to the bathroom for a few days can help you and your health care provider understand your symptoms better. A bladder diary may help show you some things that make your symptoms worse. For example, are your symptoms worse after eating or drinking a certain kind of food? Are they worse when you don't drink enough liquids?
Dietary changes: Weight loss and limiting intake of "bladder irritating" foods and drinks may be helpful. You may be asked to try avoiding coffee, tea, alcohol, soda, other fizzy drinks, citrus fruit and spicy foods. Some patients with underactive bladder may see an improvement in their condition while using lifestyle treatment options. However, many may need additional treatments before their symptoms are relieved.
Drugs may be used if lifestyle changes don't help enough. There are several prescription drugs that can be used to help improve bladder emptying with urinary retention. Your health care provider should follow you closely to look for changes and any side effects of these drugs. To get the best results, your health care provider may ask you to take different doses of the drug, or you may be given a different drug to try. Sometimes behavioral therapy will be used along with drugs.
Catheters emptying the bladders of a female and a male
Using a catheter can help you empty your bladder. A catheter is a thin, straw-like tube that is inserted into the urethra when you need to drain urine.
- Clean intermittent catheterization (CIC): This is something you can learn to do yourself. Depending on your symptoms, your health care provider may ask you to do this 3 to 4 times a day, leaving it in only long enough to empty your bladder. Sometimes clean intermittent catheterization can help improve how your bladder works after several weeks or months. However, CIC can be hard for some people whose nerve damage or other health issues cause hand coordination problems.
- Continuous catheterization: Some patients may have a different kind of catheter inserted to drain urine at all times.
Surgery is used to help some patients with more serious types of underactive bladder.
Artificial sphincter: This device helps treat severe urinary incontinence when the real sphincter muscle isn't working correctly. Surgery is required to place the sphincter cuff around the around the urethra while a pump is placed under the skin in the scrotum or labia. The pump is used to open the sphincter and allow you to pass urine.
Urinary diversion surgery: In this procedure the surgeon creates an opening called a stoma. Urine moves through the stoma to a collection pouch.
Bladder augmentation (augmentation cystoplasty): Part of the large intestine is removed and attached to the walls of the bladder. This increases the size of the bladder and helps it store more urine.
Sphincter resection: The weak portion of the urethral sphincter muscle is removed. In some cases sphincterotomy is performed, in which the entire muscle may be cut.
If these treatments don't help, your health care provider should send you to a specialist, such as a urologist, who may specialize in neurogenic bladder or incontinence. A specialist may be able to offer other tests and treatments. The treatment choices offered to you will depend on the cause of your nerve damage and the symptoms you have.
The goals of treatment are to control your symptoms and prevent damage to your kidneys. Patients who have neurogenic bladder and have more overactive bladder symptoms will have different treatment options than those with underactive bladder symptoms. No matter what the cause, treatments are focused on improving your quality of life.